Patients requiring long-term hospitalization and in nursing homes have a high potential for the development of pressure ulcers. Globally, maintaining skin integrity and preventing pressure ulcers have traditionally been the responsibility of nurses (Young, Evans, & Davis, 2003). The presence of pressure ulcers in hospitalized patients has been identified as a measure of quality in healthcare (Basten-Jensen, Cadogan, 2003). However, if unrecognized and left untreated, pressure ulcers can deteriorate into deep, hard-to-treat, chronic wounds that undermine the patient’s health and quality of life (Franks, Winterberg, & Moffatt, 2002).
Furthermore, the Australian Bureau of Statistics, for the period 2001 to 2003, recorded that 923 people died with pressure ulcers identified as either the primary or secondary cause of death (The Victorian, 2005). In addition to the human costs of pressure ulcers, there are monetary burdens as well. Several studies have reported on the costs associated with treating pressure ulcers. (Grey, Hardind, & Enoch, 2006) For example, it has been reported that total costs exceeding $318 million have currently increased to $2 billion a year.
In addition, Stotts, Deosaransingh, Roll & Newman (1998) report that higher end-costs of treatment involving pressure ulcers had increased by $20,000 between 1994 and 1995. Studies show that not only are the costs of the treatment high, but the occurrence of a pressure ulcer increases the length of hospital stay, indicating that the cost of total treatment will also increase (Eaton, 2005). Prevention is necessary to avoid compromising the fiscal vitality of health delivery systems. To date, the burden of prevention remains the responsibility of nursing professionals (Young et al.
, 2003). In spite of this fact, various studies have shown that nursing professionals have “moderate” knowledge about the prevention of pressure ulcers (Hulsenboom, Bours, & Halfens, 2007, p. 1), and less than 38 percent of health services have staff trained in wound management (The Victorian, 2005). In light of these studies and the urgency of what this statistical knowledge entails, it is therefore the purpose of this paper to highlight the relationship between nurses’ knowledge and attitudes, and the occurrence of pressure ulcers.
This document will also offer an overview of the research problem, including both the significance and rationale behind the study. It will also include a comprehensive literature review of nurses’ attitudes and perceptions towards pressure ulcers, as well as nurses’ awareness of the problem itself. The document will then outline a basic conceptual and theoretical framework and research methodology for a quantitative review of these attitudes in two hospitals. 2. Research Problem
Pressure sores are referred to as bedsores, pressure ulcers and pressure wounds. These terms may be used interchangeably throughout this document. They are generally caused by direct pressure from support surfaces and movement by the patient, as well as from shear force applied by medical devices, friction from movement on support surfaces, impaired activity, incontinence, skin exposure to moisture (Fox, 1997) and/or general lack of knowledge from the healthcare provider (Moor & Price, 2004).
The Agency for Health Care Policy and Research (AHCPR) defined a pressure ulcer as “any lesion caused by unrelieved pressure resulting in damage to underlying tissue” (Baldwin & Ziegler, 1998, p. 168). The National Pressure Ulcer Advisory Panel (NPUAP) defines pressure ulcers as follows: “the disruption of normal anatomic structure and function of the skin that results from an external force associated with a bony prominence and that does not heal in an orderly and timely fashion” (Baldwin & Ziegler, 1998, p. 168).
The inclusion of a reference to external force is important for nursing professionals treating critically injured patients who are immobilized for prolonged periods. For these patients, pressure sores often accompany such immobilization. For example, Baldwin & Ziegler (1998) report that of three studies conducted separately, spinal injury patients had the highest incidence of pressure sores. Therefore, high level of knowledge and a positive nurses’ attitude towards pressure ulcer prevention are the cornerstones to achieving prevention (Moor & Price, 2004).
Although pressure ulcers have been well studied over the last few decades, there remains a great need for pressure ulcer prevention and management strategies. Unfortunately, there is little evidence to suggest improvements in the area. The reasons for the lack of improvement have been surveyed, but the results remain unclear. While some studies have suggested that nurses have the proper knowledge to prevent pressure sores developing but do not use their knowledge, others suggest that the nurses’ knowledge of preventive strategies is deficient.
Practice guidelines on the prevention of pressure ulcers have been widely disseminated. However, the fact remains that there are some gaps and variations concerning nurses’ knowledge, attitude, and practice relating to pressure ulcers, and indeed a few researchers conclude that the knowledge is appropriate, but implementation of care is weak. Others have identified low knowledge or misconceptions about pressure ulcers. A common thread is that continued education is necessary, and pressure ulcer prevention should be a priority for all healthcare professionals.